Unnecessary procedures drive cardiology fraud investigations

Westchester Medical Center's (WMC) recent $18.8 million settlement resolving allegations of unnecessary cardiac procedures has raised patient safety concerns, along with questions about the potential for fraud and abuse among cardiology providers, according to lohud.com.

One former patient of WMC, who was also treated at two other hospitals in New York's Hudson Valley, has undergone triple-bypass surgery and "dozens of exams and procedures," along with surgeries to insert five cardiac stents, according to the newspaper. On average, Medicare pays $15,000 for a coronary stent procedure; some say this incentivizes unnecessary surgeries.

Payment data surrounding cardiac care is also leading investigators toward the potential fraud and abuse hotspot. An analysis of 2012 payment data by lohud.com shows that average Medicare payments to WMC were among the highest of any hospital in the region for procedures including stents and pacemakers. Across the nation, Medicare spends $583 billion annually on cardiac procedures, according to the media outlet.

WMC's multimillion-dollar settlement resolved allegations that the hospital gave money to Cardiac Consultants of Westchester (CCW) to open a practice that would funnel referrals to the hospital. The feds also accused WMC of letting CCW use cardiology fellows free of charge. Lohud.com points out that the allegations were similar to a 2013 New Jersey case in which Cooper Health System paid $12.6 million to settle claims it made improper payments to a cardiology practice in exchange for referrals.

"It raises an eyebrow as to whether all the appropriate consideration for proper medical treatment was taken," Evan Goldberg, president-elect of the New York State Trial Lawyers Association, told lohud.com.

Other regions of the country have seen high-priced settlements tied to unnecessary cardiology procedures. Last June, a Kentucky hospital paid $40.9 million to settle claims for unnecessary cardiac stents and diagnostic catheterizations. Additionally, a November Office of Inspector General report found that hospitals routinely submit inappropriate claims for medical device replacements, including defibrillators, pacemakers and electrical leads.

For more:
- read lohud.com article
- here's the analysis of Medicare payment data